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Diagnosis and Management of Peripheral Nerve Injuries

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 December 2021) | Viewed by 16479

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Special Issue Editor

Prof. Dr. Lukas Prantl

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Guest Editor

Klinikum der Universität Regensburg und Medizinische Fakultät, Regensburg, Germany
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Motor and sensory deficits due to traumatic lacerations of peripheral nerve structures cause long lasting functional impairment and related persisting burden in affected patients with consecutive consequences for quality of life. Neuroanatomically, the permanent disruption of axons interrupts the transmission of sensory and motor signals between the central nervous system and corresponding effector organs. Degree of nerve injury, patient age, specific level of nerve lesion, post-injury rehabilitation, time and type of repair are only few examples for the wide array of factors that strongly influence the quality of peripheral nerve regeneration. This emphasizes the necessity of a multidisciplinary approach to the challenge of optimal diagnosis and care of peripheral nerve lesions.

For this Special Issue titled “Diagnosis and Management of Peripheral Nerve Injuries”, we would like to invite authors to submit their original papers or review articles on specific and novel approaches with regard to peripheral nerve injuries. We encourage all fields of peripheral nerve research including novel diagnostic approaches, molecular aspects of nerve regeneration, concepts of conservative and surgical care, as well as advances in aftercare that significantly impact current approaches to the management of such injuries.

Kind regards,

Prof. Dr. Lukas Prantl
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Peripheral nerve injury
Nerve regeneration
Nerve gaps
Diagnosis of nerve lesions
Molecular aspects of nerve regeneration
Cell based nerve regeneration
Rehabilitation of nerve injuries

Published Papers (6 papers)

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Research

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9 pages, 2434 KiB

Open AccessArticle

Comparison of Medical and Surgical Treatment in Severe Bell’s Palsy

by Yong Kim, Seung Geun Yeo, Hwa Sung Rim, Jongha Lee, Dokyoung Kim, Sung Soo Kim, Dong Choon Park, Jae Yong Byun and Sang Hoon Kim

J. Clin. Med. 2022, 11(3), 888; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030888 - 08 Feb 2022

Cited by 2 | Viewed by 1964

Abstract

(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell’s palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell’s palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House–Brackmann (H–B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H–B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H–B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell’s palsy if they receive sufficient conservative treatment. Full article

(This article belongs to the Special Issue Diagnosis and Management of Peripheral Nerve Injuries)

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17 pages, 1740 KiB

Open AccessArticle

Multidisciplinary Care of Patients with Facial Palsy: Treatment of 1220 Patients in a German Facial Nerve Center

by Jonathan Steinhäuser, Gerd Fabian Volk, Jovanna Thielker, Maren Geitner, Anna-Maria Kuttenreich, Carsten M. Klingner, Christian Dobel and Orlando Guntinas-Lichius

J. Clin. Med. 2022, 11(2), 427; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11020427 - 14 Jan 2022

Cited by 15 | Viewed by 2373

Abstract

To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures (p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE (p < 0.001). Upper eyelid weight (3.8%) and hypoglossal–facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function (p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy. Full article

(This article belongs to the Special Issue Diagnosis and Management of Peripheral Nerve Injuries)

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10 pages, 1464 KiB

Open AccessArticle

Clinical Significance of Intraoperative Exposure of Inferior Alveolar Nerve during Surgical Extraction of the Mandibular Third Molar in Nerve Injury

by Sung-Woon On, Seoung-Won Cho, Soo-Hwan Byun and Byoung-Eun Yang

J. Clin. Med. 2021, 10(19), 4379; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194379 - 25 Sep 2021

Cited by 3 | Viewed by 2732

Abstract

During extraction surgery, the inferior alveolar nerve (IAN) can occasionally be observed in the extraction socket of the mandibular third molar (M3). The purpose of this study was to investigate and compare the incidence of IAN injury in groups with and without intraoperative IAN exposure during surgical extraction of M3, and to identify additional risk factors for the IAN injury in addition to the IAN exposure. A total of 288 cases in 240 patients, who underwent surgical extraction of M3 by a single surgeon, were divided into the exposed group (n = 69) and the unexposed group (n = 219). The surgeon recorded the information regarding the procedure when the clinical observation of IAN exposure was made during the surgery. The incidence of IAN injury after the extraction surgery was significantly higher in the exposed group than in the unexposed group (4.3% versus 0%, p < 0.05). Paresthesia was recognized in three cases of the exposed group, but it showed complete recovery within three postoperative months. No case of permanent paresthesia was detected in both groups. According to the logistic regression, the only significant risk factor of IAN injury in the exposed group was the increase of age (OR 1.108, p < 0.05). Intraoperative IAN exposure during surgical extraction of M3 may show a higher incidence of IAN injury than the case without IAN exposure, representing an incidence of 4.3%. Even if the paresthesia associated with IAN exposure occurs, it is likely to be a temporary injury, and this risk may increase with age. Full article

(This article belongs to the Special Issue Diagnosis and Management of Peripheral Nerve Injuries)

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11 pages, 939 KiB

Open AccessArticle

Association between Initial Severity of Facial Weakness and Outcomes of Bell’s Palsy

by Myung Chul Yoo, Dong Choon Park and Seung Geun Yeo

J. Clin. Med. 2021, 10(17), 3914; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10173914 - 30 Aug 2021

Cited by 5 | Viewed by 2035

Abstract

To establish whether clinical prognostic factor outcomes differed based on the initial severity of facial weakness and to determine the association between the initial severity of facial weakness and favorable outcomes. This retrospective cohort study analyzed all patients with Bell’s palsy who visited the outpatient clinic of our university hospital from 1 January 2005 through 31 January 2021. The primary outcome was the rate of recovery at 6 months, evaluated separately in patients with initial House–Brackmann (H-B) grades 3–4 and 5–6. Secondary outcomes included clinical factors associated with favorable outcomes stratified by the initial H-B grade. The rate of favorable recovery was higher in patients with initial H-B grades 3–4 than initial H-B grades 5–6 (82.9% vs. 68.2%, p < 0.001). Multivariable logistic regression analysis showed that age 19–65 years and good electromyography (EMG) results were prognostic of good outcomes in patients with initial H-B grades 3–4. In addition, good EMG results, controlled hypertension, and combination antiviral therapy were significantly prognostic of favorable outcomes in patients with initial H-B grades 5–6. Subgroup analysis interactions showed that combination antiviral therapy (OR: 3.06, 95% CI 1.62–5.78, p < 0.001) in initial H-B grades 5–6 were associated with more favorable outcomes at 6 months than with initial H-B grades 3–4. Our results showed that the proportion of patients who achieved favorable outcomes at 6 months and multiple clinical factors affecting favorable outcomes differed significantly among patients differing in initial severity of Bell’s palsy. Full article

(This article belongs to the Special Issue Diagnosis and Management of Peripheral Nerve Injuries)

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Review

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18 pages, 2766 KiB

Open AccessReview

Sensory Neurotization of the Ulnar Nerve, Surgical Techniques and Functional Outcomes: A Review

by Mỹ-Vân Nguyễn, Jérôme Pierrart and Vincent Crenn

J. Clin. Med. 2022, 11(7), 1903; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11071903 - 29 Mar 2022

Cited by 2 | Viewed by 4111

Abstract

When ulnar nerve lesions happen above the wrist level, sensation recovery after acute repair or nerve grafting is often challenging. Distal sensory nerve transfers may be an option for overcoming these sequelae. However, little data has been published on this topic. This study aims to review the surgical procedures currently proposed, along with their functional results. Six donor nerves have been described at the wrist level: the palmar branch of the median nerve, the cutaneous branch of the median nerve to the palm with or without fascicles of the ulnar digital nerve of the index finger, the posterior interosseous nerve, the third palmar digital nerve, the radial branch of the superficial radial nerve, the median nerve, and the fascicule for the third web space. Three donor nerves have been reported at the hand level: the ulnar digital nerves of the index, and the radial or ulnar digital nerves of the long finger. Three target sites were used: the superficial branch of the ulnar nerve, the dorsal branch of the ulnar nerve, and the ulnar digital branch of the fifth digit. All the technical points have been illustrated with anatomical dissection pictures. After assessing sensory recovery using the British Medical Research Council scale, a majority of excellent recoveries scaled S3+ or S4 have been reported in the targeted territory for each technique. Full article

(This article belongs to the Special Issue Diagnosis and Management of Peripheral Nerve Injuries)

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29 pages, 1173 KiB

Open AccessReview

Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring

by Alessandro Crosio, Giulia Ronchi, Benedetta Elena Fornasari, Simonetta Odella, Stefania Raimondo and Pierluigi Tos

J. Clin. Med. 2021, 10(8), 1613; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081613 - 10 Apr 2021

Cited by 4 | Viewed by 2464

Abstract

As a consequence of trauma or surgical interventions on peripheral nerves, scar tissue can form, interfering with the capacity of the nerve to regenerate properly. Scar tissue may also lead to traction neuropathies, with functional dysfunction and pain for the patient. The search for effective antiadhesion products to prevent scar tissue formation has, therefore, become an important clinical challenge. In this review, we perform extensive research on the PubMed database, retrieving experimental papers on the prevention of peripheral nerve scarring. Different parameters have been considered and discussed, including the animal and nerve models used and the experimental methods employed to simulate and evaluate scar formation. An overview of the different types of antiadhesion devices and strategies investigated in experimental models is also provided. To successfully evaluate the efficacy of new antiscarring agents, it is necessary to have reliable animal models mimicking the complications of peripheral nerve scarring and also standard and quantitative parameters to evaluate perineural scars. So far, there are no standardized methods used in experimental research, and it is, therefore, difficult to compare the results of the different antiadhesion devices. Full article

(This article belongs to the Special Issue Diagnosis and Management of Peripheral Nerve Injuries)

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