Zainab Abdallah Belal Adam

Research title

Therapeutic strategies for facial nerve paralysis regeneration..

Research topic

Peripheral facial palsy is caused by a variety of disease pathologies, including congenital

conditions, Bell’s palsy, Ramsay Hunt syndrome, Guillain-Barre syndrome, Lyme disease, HIV
infection, Kawasaki disease, central nervous system disorders, temporal bone fracture, otitis
media, Melkersson-Rosenthal syndrome, neoplasms, and malignant tumors of the parotid
gland and temporal bone [1]. It is one of the most common defect that occurs in dental
offices and can be due to trauma to the facial nerve during an inferior alveolar nerve block.
The facial nerve follows a long and complicated course from the brain stem to the facial
musculature. Most otological procedures, as well as parotid and facial surgeries, are
centered around the facial nerve, making it vulnerable to iatrogenic injuries [2].Recovery is
related to the severity of trauma as well as the severity of the symptoms. If mechanical
disruption of axons is excessive, the patient is more likely to have a longer recovery time and
severe functional outcome with sequelae [3]. In cases of severe injury of the facial nerve,
preventing extensive edema formation and inhibiting inflammatory responses are expected
to shorten recovery time and improve outcome. Neuronal edema with ischemia causes
compression of the facial nerve, which can lead to axonal degeneration and subsequent
demyelination of the facial nerve [4]. If the nerve has been transected, the recommended
treatment is direct end-to-end anastomosis or use of an autologous nerve graft, depending
on the extent (i.e., length) of the injury. The main drawback of nerve repair is its inability to
guarantee complete functional recovery. [5] According to the past researches done there
were three surgical techniques that were commonly used. The first one, one side of the
facial nerve was exposed and the branch or main stem of the facial nerve was selected.
Anastomosis was performed following full-thickness incision and injection of a specific
substance intraperitoneally or topically. The second technique, one side of the facial nerve
was exposed, and a specific substance was applied after compression injury to the main
trunk of the facial nerve. And in the third technique, one side of the facial nerve was
exposed, and the branch or main trunk of the facial nerve was selected to create a nerve
defect. The nerve, vein conduit or autograft is subsequently filled with a specific substance
and connected to the proximal and distal stumps of the nerve.

Problem analysis

The main drawback of nerve repair is its inability to guarantee complete functional recovery.
For full restoration of nerve function, the facial nerve must regenerate and expand from the
facial motor nerve while maintaining its function, and ultimately must connect to the
damaged terminal area. Therefore, in this research we are going to consider regenerative
effects of agents used to treat facial nerve, that can improve specific axon reinnervation and
prognosis in facial palsy patients. Most importantly to ensure complete functional recovery
for the patients and welcome a new Therapeutic strategy.

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The Therapeutic strategies in past researches are still in preclinical stage and needs to be
translated to clinical practice. [6] In this research the strategies are going to be done
practically on humans and the outcome is going to be followed up and any enhancements
for the treatment should be made.

Despite the abundant data from the diverse approaches used for facial nerve regeneration,
it is difficult to draw definitive conclusions regarding which combinations are most effective.
In this research pre-clinical and clinical studies are going to be done for regeneration of facial
nerve with different therapeutic strategies and to accomplish complete recovery of the facial
nerve.

Research methodology

The facial nerve paralysis regeneration treatment strategies is going to be done clinically.

Firstly, a consent from a dental teaching hospital is taken. Once a legal clinical study
agreement is made a couple of patients that are being treated in the hospital and have facial
nerve paralysis are chosen, they are to sign a consent form and the steps of the procedure is
stated to them. Then the procedure is going to be implemented.

Secondly, a team of medical health care professionals are to be asked for permission to
support the procedure.

Finally, the patients chosen are to be prepared for surgery, the cause of the facial nerve
paralysis is to be determined. Each patients is to be thoroughly examined and investigated
for any health problems.

Each surgical technique is to be implemented on each patient. Follow up, regular check ups
and monitoring for the patients is to be done for a period of time until full recovery is
achieved. The results and outcomes are to be recorded in a file for further investigations.

Research structure

The research is going to include the first chapter which is the abstract and the introduction.
The abstract includes the purpose of the research, its importance and the main outcomes.
As for the introduction the scientific background of the research topic is going to be
discussed and what is already known and unknown about facial nerve paralysis and its
treatment strategies. And finish off with the study objectives.

Then, the second chapter which is the research method where the method that is going to
be implemented is going to be discussed, the location where the research is going to be held
and the participants that will contribute to the study will be selected according to the study
design. The intervention and desired Outcomes will be mentioned. A copy of the consent
needed for the research is going to be placed. The third chapter includes the results of the
different treatment modalities implemented on the patients, the statistics of each patient
throughout a period until full recovery will be described. While the fourth chapter is going to
include the discussion, a review of the findings and comparison between the outcomes

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achieved in relation to past studies. The fifth and the last chapter shows the conclusion of
the treatment outcomes and the acknowledgments.

Achievement of the research

Facial nerve paralysis can be present at birth, can be due to syndromes and most commonly
can be due to trauma. Having facial nerve paralysis can effect the patients both mentally and
physically. With good medical care and surgical intervention the treatment of these patients
can improve the mental and physical health and provide them with a new opportunity in
their lives.

Not only providing a treatment to the patient but also to provide full recovery and the
patient can gain both his afferent and efferent nerve reflexes. This research is not only done
to implement the available approaches but to discover a new approach that can provide full
patient recovery. This can be a new intervention and treatment in neuroscience.

Resources and references

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Nerve Regeneration Based on Preclinical Studies. Int J Mol Sci. 2021;22(9):4926. Published
2021 May 6. doi:10.3390/ijms22094926