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End-to-side neurorrhaphy (ESN) is presented as a sort of surgical technique for nerve repair that has the aim to obtain a good reinnervation of the recipient nerve and function preservation of the donor nerve. Several problems regarding this technique remain to be solved. Even if ESN could find some indications in particular cases of peripheral nerve surgery, we do not think that this technique can be first choice surgery for repairing a damaged facial nerve because of the complexity of the function of facial muscles and the necessity to offer an adequate number of motoneurons from the donor nerve for reinnervation of the recipient nerve.So, despite some reports about the clinical use of facial-hypoglossal nerve ESN, we studied experimentally such technique in the rat, having as recipient the facial nerve and as donor the hypoglossus. The purpose was to establish the number of motoneurons with which the donor hypoglossal nerve innervates the recipient facial nerve, and to compare the result with that obtained after facial-hypoglossus end-to-end neurorrhaphy (EEN). Beside other interesting findings, the key point of the obtained results was that motoneuron contribution given from the donor hypoglossus to the innervation of the recipient facial nerve was limited in ESN as compared to the classic EEN.

Background: Peripheral nerve lesions usually are associated with neuropathic pain. In the present paper, we describe a simple scale to quantify pain after brachial plexus injuries and apply this scale to a series of patients to determine initial outcomes after reconstructive surgery., Methods: Fifty-one patients with traumatic brachial plexus avulsion injuries were treated over the period of one calendar year at one center by the same surgical team. Of these, 28 patients who were available for follow-up reported some degree of neuropathic pain radiating towards the hand or forearm and underwent reconstructive microsurgery and direct pain management, including trunk and nerve neurolysis and repair. A special pain severity rating scale was developed and used to assess patients' pain before and after surgery, over a minimum follow-up of 6 months. An independent researcher, not part of the surgical team, performed all pre- and postoperative evaluations., Findings: Of the 28 patients with brachial plexus traction injuries who met eligibility criteria, 93% were male, and most were young (mean age, 27.6 years). The mean preoperative severity of pain using our scale was 30.9 out of a maximum of 37 (± 0.76 SD), which fell to a mean of 6.9 (± 0.68 SD) 6 months post-procedure. On average, pain declined by 78% across the whole series, a decline that was statistically significant (p < .001). Subset analysis revealed similar improvements across all the different parameters of pain., Conclusions: We have designed and tested a simple and reliable method by which to quantify neuropathic pain after traumatic brachial plexus injuries. Initial surgical treatment of the paralysis--including nerve, trunk and root reconstruction, and neurolysis--comprises an effective means by which to initially treat neuropathic pain. Ablative or neuromodulative procedures, like dorsal root entry zone, should be reserved for refractory cases.