Direct muscle neurotization in facial paralysis. (Field: Reconstructive Microsurgery)

Direct Muscle Neurotization

Direct muscle neurotization is a medical procedure used to treat the problem of denervation and it involves the removal of the whole neuromuscular junction (13 ) This method has been developed to address the negative results of different nerve transfer procedures which are mostly caused by neuron death or misdirected growth at the suture site by transporting intact nerve fibers straight to the target muscle (10 )The idea of direct muscle neurotization is to remove a neuromuscular junction from a non-denervated muscle to a part of a denervated muscle The

donor neuromuscular junction may originate from a paralyzed or voluntary muscle . If the source is one under voluntary control , then the end-plate zone is harvested and transferred to the targeted recipient muscle . If the source is a paralyzed muscle then it is mandatory to provide a command source for the donor muscle . One method to provide a command source is the combination of DMN with end-to-side neurorrhaphy (1

Neurroraphy is a technique used to attach a donor nerve to a type nerve It also includes the implanting of donor neuromuscular junction , along with small pieces of donor muscle , to an identified recipient muscle With this technique a command nerve will be able to exert control on a muscle it did not previously control (1

The anatomical and physiological principles involved with nerve transfer are fairly simple . Restoration of motor function is the priority goal and with this , selection of a donor nerve element with adequate motor fibers is a prerequisite . The nerve transfer procedure must not result to a loss of critica function of the donor muscle . The technique is advisable if the value of the neuromuscular element targeted exceeds the utility of the sacrificed muscle . A compromised comes along if the there would be retention of the some of the functions of the donor muscle with the use of a portion of the nerve stump as a donor specifically the distal terminal branch (1

Principles involved in the utilizitation of nerve transfer include the proximity of the donor nerve . It is advisable to reinnervate the recipient nerve with lesser distance to target muscle as possible Another principle to bear in mind is performance of a direct repair without the utilization of grafts , this is reported to produce improved outcomes . Third principle , in choosing donor and target muscle , use combinations of similarly behaving neuromuscular units . Functional recovery is the main objective when utilizing cortical re-adaptation (13

Surgical Technique of Neurotizing a Muscle

Neurotization or nerve transfer is technique used to repair a distal denervated nerve element with the use of a proximal nerve as a donor of neurons and their axons . This technique is intended to reinnervate he distal targets . Although this technique sacrifices the function of the donor muscle , it is still used to revive the function of the recipient nerve and muscle (13

Nerve transfer has been utilized with increasing rate in the repair of brachial plexus injuries . Mostly in cases where the proximal motor source...